The Good Doctor (2017–…): Season 3, Episode 14 - Influence - full transcript

After Shaun treats a famous patient, he deals with unwanted attention. Carly's efforts to separate Shaun from Lea are challenged.

(SIGHS) What?

It's time to wake up.

Mnh-mnh. It's still
dark outside.

I'd like to have sex.


As romantically as that was put,

it's too early, Shaun.

It's exactly early enough
to have sex

for the average duration
it takes us

and still allow
precisely enough time

to get ready for work.


How long have you
been up figuring that out?

Since 4:53.

But it only took two minutes.

You've been waiting
since then to propose this?

I let you sleep
as long as possible.

That's... very considerate.







Sorry, I'm late.

I'm Dr. Shaun Murphy.

Kayley has a sore throat.

HOARSELY: More like
this constant feeling

like there's something
stuck in my throat.

And I've fainted a couple times,

which I first thought
was just random.

And I'm obviously
losing my voice.

Since I've only just met you,

I have no idea what your
voice normally sounds like.

Well, not this.

Sometimes when swallowing,
I get a super intense pain,

like, worse than
an ice cream headache.

My internist sent me to an
ear, nose, and throat guy,

an orthopedic surgeon,
um, three gastroenterologists,

a voice issues specialist dude.

An otolaryngologist.

A-a neurosurgeon who thinks
it might be a messed up nerve

connecting the throat
to the brain.

The ninth cranial nerve,
glossopharyngeal neuralgia.

He recommended,
like, brain surgery.

Microvascular decompression.

Which a second neurosurgeon
said I don't need.

You're not happy with
the answers you're getting

from a whole bunch
of recommended specialists,

so you came to the ER?

I ran out of
recommended specialists.


It is an intriguing
combination of symptoms.

We'll admit you
and run some tests.

Uh, Dr. Murphy?



I have autism.

That's so cool.

Uh, I mean, no...

Sor... Not... Not cool
that you are.

Be more insensitive,
Kayley. Um...

It's cool that you're this...

Totally chill,
super knowledgeable medico.

Compliments... are very awkward.



Cute doctor who's gonna cure me.

Severe abdominal discomfort.

Fever, tachy, hypotensive.

It's okay, sweetie.

What's your name?

That's Marla.

No one to leave her with.

We're gonna take care
of your mommy.


Abdomen tender and distended.



Delayed capillary refill.

Rapid respiratory rate.

Skin cool and bluish,
looks cyanotic.

She's going into shock.

We need aggressive
fluid resuscitation.

Start broad spectrum

place an NG to decompress
distended abdomen.

Trend her lactates, initiate
complete sepsis bundle.



Her CBC, BMP autoimmune panel,

nasal swab, and blood cultures.

All normal.

Ohh. That's exciting.

Negative tests are exciting?

No one's been able
to find out what she has.

I'm going to get brain FIESTA
and time-of-flight MRI

to assess the cranial nerves
and vessels,

and Doppler ultrasound to...

I have to get back to work.

Our pre-dawn romantic
interlude made me late.

Yes. There was a flaw
in my methodology.

My calculation was based on

the mean duration of our sex
overall, but generally,

we take statistically
significantly longer

in the morning
than at other times of day.

Well, maybe we can discuss

this whole timing-our-sex
thing at lunchtime.

Mm. No, thank you.

I can't have lunch today.

Too much to do.


Sorry I'm late.

I was going to cancel our lunch.

Let me guess.

A patient
more interesting than me.


(SIGHS) Yeah.

She has a mysterious condition.

But I realized I could use our
lunch to help understand it.

I ordered you a salad.
Thank you.


How do I get
an ice cream headache?

I've never had one.

You don't want one.
Brain freeze is horrible.

The scientific term

is sphenopalatine

The trigeminal nerve reacts to

rapid temperature change
in the mouth,

sending a signal to the brain,

which responds with changes in
blood flow and dura irritation,

which combats what it perceives
as a dangerous, noxious stimuli,

but is just ice cream.

I need to experience that.


The technique I usually use is,

eat way too much, way too fast.


(INHALES) I'm quitting my job.

The job you came back
from Hershey for?

Don't tell Glassy.
He already thinks I'm a flake.

You kicking me out
is just what I needed.


I was in a complete rut.

In my personal life,
at work, super stale.

I mean, we weren't
developing anything,

just market testing designs...


Ow! Ow, ow!

That's awful!

What's the cure? Time.

How much time? Depends.

Do you think I should include
my job in Hershey on my resume?

It hurts so much!

Or does it make me look like

I'm unable
to commit to anything?



The ultrasound showed
your colon is distended.

We placed a rectal tube
and an NG

to try to get that decompressed.

Mommy, can we go home?

Not yet, sweetie.

It would be helpful
to try to find out

what could've triggered this.

Any history of Crohn's
or ulcerative colitis?


I, um...

I have had some UTIs lately.

That's likely not connected.

Okay. PARK: Diverticulitis?

Any recent international travel?

I have a three-year-old
and no husband.


We're gonna need
to keep you on IV antibiotics

and monitor the distention.

In the meantime,
is there anyone who can look after Marla?

No one.

My whole family's back east.
It's... It's just us.

I'll get a social worker
to look after her.

Thank you.

Go ahead, honey.



Why is my mom upset?



If her anterior inferior
cerebellar artery

is encroaching
on her glossopharyngeal nerve,

it's very minor.

Certainly not enough to justify

decompression surgery.

I agree.

It could also be acid
reflux temporal arteritis,

laryngopharyngeal dysesthesia.
We need to...

We need to do $50,000 of tests,

and it might be acid reflux?

Or temporal arteritis or...

It's a constellation

of relatively insignificant

Have you ever had an ice cream
headache, Dr. Andrews?


I believe it didn't require
brain surgery, Dr. Murphy.

As a compromise,
we could do an MRI

and CT her neck and a swallow...


You don't compromise
with your boss.

Start her on dilantin for
her pain and send her home.



Can I just leave her with you?

I'm a receptionist,
not a social worker.

And I'm a surgeon.

I didn't mean
I'm more important.

I just meant we both have
more important things to do.

When will the social worker
be here?

She said half an hour.

Can you page her again?

I want my mama.

Why don't you just go play
with the toys, okay?

Do you have her number?
I'll call her myself.

I made Mommy sick.

No, sweetie.
It's not your fault.

Sometimes people just get sick.

Mommy drawk ma poop.

Your mommy drew your poop? No!

Drawk. Mommy drawk.



Mommy drawnk my poop.


The good news is, we've ruled
out glossopharyngeal neuralgia.

You don't need brain surgery.

Never any good news
without bad news.

We've got a list of
a few things you don't have,

but we don't know
what you do have.

So you'll run more tests.

We can't.

There are 21 different things
this might be,

but they don't want us
to run 37 more tests.

Well, this is lame.

I can afford the tests.
I make good money.

keep talking like this!

I need a...


She's hypotensive.

Code stroke.

We need stat brain CT and MRI.

Call angio. She may need
mechanical thrombectomy.


3 cc's of 2% lidocaine.







Wow. (GASPS)


I-I didn't drink it. I just...

I just used her stool
to do a home fecal transfer.

And you didn't think
to mention that?

You said my UTIs were unrelated.

They didn't get better
with antibiotics,

so I did exactly
what I was supposed to do.

The video swore that
it was completely safe.

Make sure your friend
is completely healthy.

I've had the best results
with vegans,

though if it were between

an 18-year-old carnivore
and a 60-year-old vegan...

Well, don't make me choose.

We're gonna add
the saline solution.

Should be a one-to-one match,
more or less.

Then, we're gonna puree...


puree, and then puree some more.

While it's mixing...

Let's talk enema bags.


Marla must have seen her
using the blender,

assumed she drank it.

Yeah, that's the mystery here,

not how anyone
this stupid is still alive.

It's not completely irrational.

The E. Coli strain
in drug-resistant UTIs

can hide out in the gut.

Repopulating the
colon microbiome using FMT

has shown some success.

In a hospital,
under controlled and sterile conditions.

Prep her for surgery.

Between the dilation
and rigidity,

there may be colon perforation.

And test Marla's stool for
toxins and infectious bacteria.

She was suffering a
mini-stroke, and I saved her.

I saved her.
I need to celebrate. Outside?

I want to celebrate
by kissing you.

A lot.

I-Inside would be inappropriate.


Eagle Syndrome is very rare.

A longer-than-normal
styloid bone

coming off the base
of the skull.

I only get a five-minute break.

It impinged on her nerves,

causing the confusing symptoms

that baffled
eight expert doctors.

And then when she
turned her head suddenly,

it pinched her carotid,
causing her TIA. (LAUGHS)

Yeah, it's him! (GASPS)

It's Dr. Murphy!


How do I know you?


Is that his girlfriend?

Kayley's hotter.



WOMAN: He's so cute!



My personal... Chernobyl.

(LAUGHS) What?

Seriously, guys.

Ohh, come on.

A zone of exclusion should
be imposed around my kitchen.


Millions of people
have watched that?

HOARSELY: As of 9:00 a.m.

You're an influencer.

And you posted how I saved you?

But I take it I'm not saved yet?
You still have to operate?

A normal styloid process

is 2.5 centimeters
in length. Yours measures...

Don't do that.

There are two surgical options.

Transoral, where we go in
through your mouth.

It's non-invasive, but
creates surgical challenges

for physical and visual access.

The alternative
transcervical procedure

involves an incision
in your neck

with none of those
access issues,

but with some
post-operative scarring.

So one way is safer,
but the other way, I'll look better?

It's a pretty bad-ass scar.


Can I take a bit
to decide which?

Of course.

You had no right
to tell the world about me.

It was flattering.

Not everyone wants to be famous.

Uh... If it's any consolation,

you've had over
70 marriage proposals.

It's not.


Some of us are more comfortable
in the spotlight than others.

I think you're great.



MARLA: I don't have to poop.

Be patient.

I don't have to poop!

Is there something your mom does

to help you when you can't go?

MARLA: Sometimes
she hold my hand.

Would you like me to?

MARLA: You're not my mom.

Well, just keep trying.

MARLA: Pbbbbbbht.


Sweetie, we really
need you to go.

If you can't,
there is another way we can do this.


CLAIRE: Well, it's not fun.

For either of us.



MELENDEZ: Isolate and divide
middle colic artery and vein.

It's an epidemic.

People taking
online medical advice.

CLAIRE: It's not the problem.
It's the symptom.

Medical care is a financial
stress for lots of people,

not to mention
physician arrogance,

incompetence, impatience.

So it's our fault?

Resect and cut the colon
proximal and distal

to the perforation
with GIA stapler.

A friend of a friend

her own Cushing's disease online

after a series of doctors
barely listened to her,

told her to get more rest.

I'm guessing
she didn't then perform

brain surgery at home.


Claire's right.

I was... supporting your point.

She convinced me I was wrong.

Divide mesentery with LigaSure.


WOMAN: We have a bleed.

It's major.

Tension during mobilization

must have caused
a splenic capsule tear.

We need to do a splenectomy.

Cut the connecting attachments.




Take the vascular pedicle
with a white load stapler.

Do not get the tail
of the pancreas.




Dr. Melendez?

Can this wait?

I'm not sure.

The fecal sample
that your team sent me...

(SIGHS) It might be normal,
but was it mislabeled?

It seems to be
from a 70-year-old.

It's from a three-year-old.

SCFAs, elevated isobutyric
and isovaleric acid.

She is at high risk
for serious cardiac problems.



Oh, are you okay?

Her social media posts
about Shaun have gone viral.

I've got reporters
clamoring to speak

to the "twice-exceptional"
Dr. Murphy.

Bad idea.
Luckily, he won't do it.

He went off on Kayley
about his privacy.

The publicity would be good
for the hospital.

And I'm sure Dr. Glassman can
make him see the wisdom of that.

MELENDEZ: I'm with Andrews.

It smacks of us
patting ourselves on the back.

It could also come off
as exploitative.

But the bigger issue is,
it could blow up in our face.

Shaun is a complete
communications wild card.

Who knows what he'll say
about you, about me,

about being demoted,
about screw-ups.

Well, we would
have to coach him.

Do we have six years before
they need to go to press?

I can go with him,
manage the situation.

GLASSMAN: No, no, no.

If we consider Shaun an asset,

we shouldn't treat him
like a liability.

I'll talk to him,
see what he says.

You can see the proximity
of her elongated styloid

to the nerves and carotid.

The trick is to break off
the excess length

without injury to local
neurovascular structures.

If done transcervically,
entry point is key.

Minimizes risk of a marginal
mandibular nerve injury.

Has she made a decision?

SHAUN: Not yet.

I'd like to lead.

Being that it's such
a rare surgery,

I may not get another chance
at it during residency.

When I have the benefit
of supervision.

And it wouldn't have
anything to do with hoping.

Kayley might then post
glowingly about you?

Not at all.

Well, undoubtedly, a little.

Given the attention
this case has drawn,

I think we should put our best,
most experienced choice forward.

Well, this is
a teaching hospital.

It's exactly the type of surgery
we'd give to a third-year.

The fact that she has
an online presence

shouldn't be a factor.

And yet here you are,
the Chief of Surgery

working a case you say
a third-year can handle.

It also might reflect
well on this place

to have a young woman be the
face of Kayley's surgery.

Assuming it goes well.

Live by the Internet,
die by the Internet.

You still want to lead?


It's yours.










Am I okay?

You're fine.

We had to wake you up a
little earlier than we'd like

because we need to discuss
something with you.

Do you understand?


Your gut biome showed markers
for elevated cholesterol.

Which you don't have.

Your daughter does.

Marla has high cholesterol?

She has a genetic
condition: Hyperlipidemia.

Coronary testing
showed 90% narrowing

of the left main artery
to her heart.


I'm afraid your daughter
needs urgent heart surgery.

I don't want to.


I'll tell the reporters that.

But can... can we
talk about why?

computer just beeped.

I know.

I can think of a few reasons
why you might be reticent.

You're shy. No, I'm not.

Well, you do have trouble
with social interactions,

and you have
trouble anticipating

what people might ask
and how you might respond.

Yes, that is a problem when
I'm meeting with a patient

or I'm at a job interview
or I'm on a date.

Then my answers matter.

But if I'm talking to a
reporter, they don't matter.

It beeped again.

Yes, I know. We're digitizing.

Every time a patient
needs to take a drug,

we send them a reminder.

For some unknown reason,
they keep sending me one, too.

I think stories do matter.

I think what you do
and what you have done

might be inspirational
for people to hear.


Okay, you'll do it?

Okay, you've convinced me
I should be nervous about it.

Now I have two reasons
not to do it.

What's the other reason?

I'm very busy between doing
my job and having sex.

I don't have a lot of free time.


You should hire Lea.

No. SHAUN: Yes.

She's very good at tech

and isn't happy
in her job right now.


I'll tell you what, Shaun.

You think about this,
you really think about this,

how your story
can benefit people,

and I will...

Interview Lea.


I'll think about it.

I'll really think about it.




Some people definitely thought
I would look amazeballs

rocking a neck scar.

But the consensus was,

there's only so many
turtleneck days in a year.

So I'm going with
the no-scar approach.

Which one did you vote for?

Well, these are my people.
I mean, they know me.

They know what's best for me
and my brand.

"Wisdom of the crowd."

My warrior goddess lead surgeon.


We'll get you prepped
for surgery.

New blouse? It's nice.

Dr. Murphy,
do you have a minute?

I really am sorry I upset you.

And I really am grateful.

Being sick was...

You don't need to explain

why you're grateful
we diagnosed your illness.

Well, I do.

You saved me
and my career. (CHUCKLES)

At first,
my followers were super into

what I was going through,
but after a while,

you just start being
"the sick girl."

You give up your privacy.
Doesn't that bother you?

I have nothing to hide.

No one should.

We should all just be
who we are.

We are...

The decisions we make.

And you let other people
make them for you.

So you're not being anyone.


You know how you and I like
to do so many things together?

We make clay mugs.

That's right.

Mommy was sick,
and she needed to be fixed.

And you're sick, too.

I don't feel sick.

That's good.

And the doctors
just want to make sure

everything is all better
before you do.


They're gonna
go inside you and...


They're gonna make
a little cut...


You're gonna be asleep.

No! Just like Mommy.

I... No, no, no, no, no!

I'll be with you, Marla.
I'll take good care of you.

No, no, no, no, no! It's okay.
Just breathe, sweetie.

Count to three. No!

Hey, sweetie,
you have to be brave. No!


Code blue!

What's happening?

Please help my baby.

She's had a heart attack!




Uh, would you like my CV?


I know who you are.
I don't need to see a list.

Where do I work?

It's a tech company.

You were there.

Cars. Something about cars.

You have no interest
in hiring me, do you?

No. It's not personal.

It's a little personal.

I'm doing a favor for Shaun.
I don't really need anyone.

Did he ask you to waste my time?

Yeah... It's okay.

I didn't really want
to work for you anyway.

You're a bit of a grouch.

But make sure whoever does do
the job shores up your firewall.

A kindergartner can hack it.

Thank you.
I'm sure we'll be fine.

And you're right, you know.

We are not a good fit.

And our mutual affection
for Shaun

isn't enough to stop us
from killing each other.


Your Chronicle subscription
is about to expire

because they don't have
your updated credit card.

The coffee maker you ordered,

third new one
in the last six months,

will be delivered Tuesday.

And you're deducting
way too much money

out of Debbie's paycheck
for FICA.

Would you like to hear
about your Google searches?


Thank you.


(SIGHS) Lea!


Severe proximal LAD disease
with mid total occlusion.

Angioplasty won't resolve
that stenosis.

High risk of rupture
in someone this young.

A stent?

Won't be enough
effective revascularization.

She needs a left IMA
to LAD anastomosis.

I've never done a coronary
bypass on a three-year-old.

Neither have I.

I guess it was the right call

to put her daughter's poop
up her tush.

Cost her a large chunk
of her colon.

Saved her daughter's life.
Yeah, lucky coincidence.

I'm sure the mother
doesn't regret a thing.

At least she shouldn't.

I'm with Claire.


Do you have time for lunch?

And by "lunch," you mean...?


I need advice.

I need to really think
about something.


Then yes, of course.

CARLY: It could be patronizing,

being put up as some kind of
feel-good, human interest story.

Or objectified and glorified

as some kind of a symbol
for people who are different.

But I also know that when I
told my sister your story,

she cried.

She was sad?

No, she was inspired.


I... don't know what your
advice is telling me.

I don't know what you
think I'm supposed to do.

Shaun, you aren't
supposed to do anything,

except what you
believe is right.

(SIGHS) Thank you.

Now I'm going to go see
what Lea thinks.

I thought you had a surgery.

I'm just going upstairs.

Lea's meeting with
Dr. Glassman about a job.

A job here? Yes.

Lea told me at lunch yesterday

that she was looking
for different work, so...

Wait, you... you had lunch
with Lea? Yesterday?

And... And you kept it from me?


I didn't keep it from you.

There was no reason
to mention it

until just now, when I did.


You know how I feel

about how Lea hovers
over our relationship.


You're just sneaking
around with her?

Arranging for her to work here,

where she'll just loom
all the more.

She won't be looming
or hovering.

She'll be
on a whole other floor.

Yeah, where you can go
and get her two cents

whenever the advice given
by your actual girlfriend

is deemed insufficient.









What are you doing?

Eh, fresh air.



Shaun lied to me
about having lunch with Lea.

No, he didn't.

Shaun is incapable of deceit.

He must have genuinely thought
that you wouldn't mind.

Well, then, he is completely
tone deaf and insensitive,

which are not better qualities
in a boyfriend.


But not exactly unanticipated

when you get into
a relationship with Shaun.

And it's never
really about the lie.

It's what's underneath.

You're jealous of Lea.

I am not jealous.

I am concerned...

You don't need to justify.
I'm on team jealousy.

It's flattering,
stimulating, it...

It means you're committed
and you care.

It's ugly and reflects
underlying trust issues

that I don't want to...

Yeah, yeah, yeah,
like all things,

a little is good,
and a lot will kill you.

My advice...

Admit you're jealous,
give in to it,

and then get over it.




MORGAN: Finding the styloid

via digital palpitation
of the tonsillar fossa.


Making incision vertically
along the mucosa of mandible.


I will free the styloid
process from its muscle

and ligament attachments.


Dissecting away from
the internal carotid medially,

and external, laterally.

Now fracture and excise
the styloid.



SHAUN: Bradycardia. Hypotensive.

Loss of EEG waveform.
Cerebral ischemia.

You may have injured
the carotid.

Or compressed it
by fracturing the styloid.

See if the fragment
is impinging on the vessel.

Dr. Murphy, extend her head.



Yes. Found it. Easing it away.


Carotid decompressed.


EEG back to baseline normal.


Resuming styloid extraction.


Kayley's in ICU, stable.

CT shows no signs
of any permanent damage.

No reason to anticipate
any future problems.

So, the question is,
what do we tell her?

That the surgery was a success.

She had a cerebral ischemia.
On the table.

That did no damage and that
there's no evidence of.

Hospital policy
is transparency...

We don't tell them
what music we played,

what we talked about.

This isn't relevant to the
outcome or to her prognosis.

Would you be taking
the same position

if Kayley wasn't someone whose
criticism could go viral?

ANDREWS: I don't know.

But it would be delusional
to think it's not relevant.

Dr. Reznick.

Any thoughts?

I don't think I can
fairly offer an opinion,

because my career
could hang in the balance.

Yeah, well, none of us
are disinterested parties,

given the hospital's
reputation is also at stake.

Did you screw up?

Could that crisis
have been avoided?


If it could have been,
then we are all responsible.

We were watching
everything she was doing,

and none of us told her to stop.

This is an easy call.

There's only one reason
to tell her everything,

and that's you might
feel guilty if you don't.

On the other hand, there's
the future of this hospital.




Shaun, if the patient asks
for details about the surgery,

can you limit your answers?


I... don't know.

Okay, we need to know if...


Dr. Murphy, I hope
you will limit your answers.

But I won't order you
to defy your conscience.


We don't normally have
patients share rooms, but...

Gonna be completely fine.

And once she's recuperated,
we'll begin her on statins and Ezetimibe,

and she'll undergo
lipid apheresis.

It's kind of like dialysis,

but it'll allow us to
extract LDL out of her blood.

Should get her cholesterol
to within normal range.

She'll need those drugs
and that other stuff

for the rest of her life?

Yes. But hopefully
a very long one.


(SNIFFLES) Thank you so much.

Thank God I did what I did.




Everything went great?

(SIGHS) The repair was successful.
You should have no...

KAYLEY: Everything went great.
Say it. Say it to your fans.

Everything went great.

KAYLEY: You rocked it.

(CHUCKLES) You'll be with us
another few days, and then you...

KAYLEY: She rocked it, right?

She was lead surgeon
in a successful...

KAYLEY: And how gorgeous
is that hair?

Dr. Morgan Reznick, take a bow!


KAYLEY: She was wrist-deep
all up in my mouth, y'all.

She is a damn hero!


You've got work to do.

We're proud of you.

Any reason you screwed up?

I didn't. It could've
happened to anyone.

Not anyone suffers
from arthritic pain.

That didn't affect anything.

You sure about that?

'Cause I'm not.

CARLY: Did you speak to Lea?


I know she's a good friend.

And it would be unfair

for me to expect you
to cut her out of your life.


You going to ask her opinion
right after I had given mine,

it just called up Wyoming
all over again.

That you preferred Lea to me.


I was jealous.

And it's something
that I have to work out.


For the two of us to work out.




What was Lea's advice?


That it'd be selfish not to
share my story with the world.


I liked your advice better.





Actually, yeah.

There's something awkward
we need to talk about.

You and Claire.

You can reopen the door.

There's nothing
remotely improper going on.

I received an anonymous
favoritism complaint.

We need to deal with it.

I don't want
to talk to reporters.

I know.

So if I talked to reporters,

it wouldn't be honest
to who I really am.

Well, sometimes, Shaun,

people present a different
version of themselves

depending upon
the circumstances.

Like, I'm not always
the same here as I am at home.

I don't.

No, you don't.

I considered all the arguments.


I want to be known
as a good doctor.

Not a good autistic doctor.